title: Living Smart, Living Fit: a patient-centered program to improve perinatal outcomes in a community health center population.
abstract: BACKGROUND
  Depression and obesity/overweight during pregnancy are important public health concerns, as they are frequently associated with poor birth outcomes. The Living Smart, Living Fit® (LSLF) program was an intervention program initiated in 2008 to provide comprehensive care to low-income pregnant and postpartum women with elevated body mass index (BMI) and depressive symptoms. It linked patients to clinical care coordinators trained in motivational interviewing who promoted participation in a portfolio of mental and physical wellness activities.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the effectiveness of LSLF in improving depression, BMI, birth weight, and smoking status among low-income perinatal patients.
  
  
  METHODS
  Women with Patient Health Questionnaire (PHQ-9) depression scores ≥10 and/or BMI >25 kg/m(2) at their prenatal intake visit were eligible for enrollment into the LSLF program. Enrolled participants met with clinical care coordinators who encouraged engagement in a portfolio of LSLF activities that included pregnancy/family, physical health, and mental health interventions. Outcomes were measured at the 6-week postpartum visit and included change in PHQ-9 scores, change in BMI, birth weight, and change in smoking status.
  
  
  RESULTS
  Of the 107 enrollees, 86% participated in some LSLF activity. Participation in pregnancy/family related activities was significantly associated with decreased PHQ-9 scores. Participation in mental health services was significantly associated with increased birth weight. No changes in BMI or smoking status were associated with LSLF involvement.
  
  
  CONCLUSIONS
  The findings of this pilot study indicate that pregnant women with depression or obesity/overweight can benefit from care coordination and a portfolio of activities for mental and physical wellness. The LSLF program provides a model for delivering this patient-centered comprehensive support. Further research should include more controlled trials to better evaluate the effectiveness of LSLF intervention.
authors.affiliation: Community Health Center, Inc, Middletown, CT 06457, USA. nwando@chc1.com
authors.forename: J Nwando
authors.initials: JN
authors.lastname: Olayiwola
authors.forename: O Corazon
authors.initials: OC
authors.lastname: Irizarry
authors.forename: Kelli
authors.initials: K
authors.lastname: O'Connell
authors.forename: Stephanie
authors.initials: S
authors.lastname: Milan
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D015992:Body Mass Index; D003151:Community Health Centers; D003376:Counseling; D003863:Depression / Q000150:complications / Q000628:therapy*; D003866:Depressive Disorder / Q000150:complications / Q000628:therapy; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008603:Mental Health; D008605:Mental Health Services; D009765:Obesity / Q000150:complications / Q000628:therapy*; D050177:Overweight; D018802:Patient-Centered Care; D010865:Pilot Projects; D011203:Poverty; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology / Q000628:therapy*; D011256:Pregnancy Outcome; D011295:Prenatal Care; D015397:Program Evaluation; D012907:Smoking; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: community health; health outcomes; health promotion; obesity; perinatal care; physical activity